Fragment wound pseudoaneurysm presenting 54 years after injury(1)

A 74-year-old man presented with acute arterial insufficiency of the left leg. Surgical history was remarkable for a mortar fragment injury to his proximal medial left thigh in 1945. His wounds healed secondarily after operative debridement. He denied any knowledge of a vascular repair. He was asymptomatic until his acute presentation with a threatened limb.Physical examination demonstrated an acutely ischemic extremity with moderately impaired neurologic function and a pulsatile mass over the proximal superficial femoral artery (SFA). Arteriography demonstrated an SFA pseudoaneurysm in proximity to multiple mortar fragments with intraluminal clot and distal arterial obstruction. The extremity was successfully revascularized with embolectomy of the distal arterial thrombus and repair of the arterial injury and pseudoaneurysm with reversed contralateral saphenous vein.This case represents the longest reported delayed presentation of a traumatic false aneurysm. It emphasizes that proper assessment of underlying potential vascular injury must be performed if delayed complications are to be avoided. Comparisons between the unique challenges presented by combat associated injury versus those seen in today's civilian environment are emphasized.